Search

Abstract Background Sickle cell disease (SCD) is a chronic disease associated with high degrees of morbidity and increased mortality. Health-related quality of life (HRQOL) among adults with sickle cell disease has not been widely reported. Methods We administered the Medical Outcomes Study 36-item Short-Form to 308 patients in the Pain in Sickle Cell Epidemiology Study (PiSCES) to assess HRQOL. Scales included physical function, physical and emotional role function, bodily pain, vitality, social function, mental health, and general health. We compared scores with national norms using t-tests, and with three chronic disease cohorts: asthma, cystic fibrosis and hemodialysis patients using analysis of variance and Dunnett's test for comparison with a control. We also assessed whether SCD specific variables (genotype, pain, crisis and utilization) were independently predictive of SF-36 subscales, controlling for socio-demographic variables using regression. Results Patients with SCD scored significantly worse than national norms on all subscales except mental health. Patients with SCD had lower HRQOL than cystic fibrosis patients except for mental health. Scores were similar for physical function, role function and mental health as compared to asthma patients, but worse for bodily pain, vitality, social function and general health subscales. Compared to dialysis patients, sickle cell disease patients scored similarly on physical role and emotional role function, social functioning and mental health, worse on bodily pain, general health and vitality and better on physical functioning. Surprisingly, genotype did not influence HRQOL except for vitality. However, scores significantly decreased as pain levels increased. Conclusion SCD patients experience health related quality of life worse than the general population, and in general, their scores were most similar to patients undergoing hemodialysis. Practitioners should regard their HRQOL as severely compromised. Interventions in SCD should consider improvements in health related quality of life as important outcomes.

Context: Health care utilization and the occurrence of non-time-loss (NTL) lateral ankle sprains is not well documented in collegiate athletes but could provide better estimates of injury burden and inform clinician workload. Design: Descriptive epidemiologic study. Methods: Lateral ankle sprain injury occurrence for Division I collegiate student-athletes in a conference with 32 sports representing 732 team seasons was collected during the 2018–2019 through 2020–2021 academic years. Injuries were designated as acute or overuse, and time-loss (TL) or NTL. Associated health care utilization, including athletic training services (AT services), and physician encounters were reported along with anatomical structures involved and season of occurrence. Results: A total of 1242 lateral ankle sprains were reported over the 3 years from 732 team seasons and 17,431 player seasons, resulting in 12,728 AT services and 370 physician encounters. Most lateral ankle sprains were acute-TL (59.7%), which were associated with the majority of AT services (74.1%) and physician encounters (70.0%). Acute-NTL sprains represented 37.8% of lateral ankle sprains and were associated with 22.3% of AT services and 27.0% of physician encounters. On average, there were 12.7 (5.8) AT services per acute-TL sprain and 6.0 (3.6) per acute-NTL sprain. Most sprains involved "ankle lateral ligaments" (45.6%), and very few were attributed to overuse mechanisms (2.4%). Conclusions: Lateral ligament sprains are a common injury across many sports and result in substantial health care utilization from ATs and physicians, including NTL lateral ankle sprains. Although TL injuries were the majority of sprains, a substantial proportion of sprains were NTL and accounted for a considerable proportion of health care utilization. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate if and to what extent student service members/veterans differ from civilian college students in the prevalence of self-reported symptoms of poor mental health. Participants: The Fall 2011 implementation of the American College Health Association-National College Health Assessment included 27,774 respondents from 44 colleges and universities. Methods: Participants were matched using propensity scores, and the prevalence of symptoms was compared using logistic regression and zero-inflated negative binomial regression models. Results: The odds of feeling overwhelmed in the last 12 months were significantly lower among student service members/veterans with a history of hazardous duty (odd ratio [OR] = 0.46, adjusted p value <0.05) compared with civilian students. Military service, with and without hazardous duty deployment, was not a significant predictor of the total number of symptoms of poor mental health. Conclusions: Current student service members/veterans may not be disproportionately affected by poor psychological functioning.

Objective To evaluate program and health care costs of a lifestyle intervention in a high-risk obese population. Design Twelve-month randomized controlled trial comparing lifestyle case management to usual care. Subjects/setting Health plan members (n=147) with obesity (body mass index [greater than or equal to] 27) and type 2 diabetes. Intervention Lifestyle case management entailed individual and group education, support, and referrals by registered dietitians. Those in the usual-care group received educational material. Main outcome measures Medical and pharmaceutical health care costs reimbursed by the participant's primary insurance company. Statistical analysis Total costs were modeled using the four-equation model using previous year cost as a predictor. Results Net cost of the intervention was $328 per person per year. After incorporating program costs, mean health plan costs were $3,586 (95% confidence interval [CI]: -$8,036, -$25, P<0.05) lower in case management compared to usual care. The difference was driven by group differences in medical (-$3,316, 95% CI: -$7,829 to -$320, P<0.05) but not pharmaceutical costs (-$239, 95% CI: -$870 to $280, not statistically significant), with fewer inpatient admissions and costs among case management compared with usual care (admission prevalence: 2.8% vs 22.5% respectively, P<0.001). Conclusion Addition of a modest-cost, registered dietitian-led lifestyle case-management intervention to usual medical care did not increase health care costs and suggested modest cost savings among obese patients with type 2 diabetes. Larger trials are needed to determine whether these results can be replicated in a broader population. The findings can be judiciously applied to support that the addition of a registered dietitian-led lifestyle case-management program to medical care does not increase health care costs.

Commercial fishing is a high-risk occupation, yet there is a lack of surveillance documenting health conditions, health behaviors, and health care coverage among US fishermen. We used publicly available data sources to identify exposures and health outcomes common among fishermen. We utilized the National Institute for Occupational Safety and Health–Worker Health Charts to estimate the prevalence of general exposures, psychosocial exposures, health behaviors, and health conditions from the national surveys National Health Interview Survey – Occupational Health Supplement (NHIS-OHS, 2015) and Behavioral Risk Factor Surveillance System (BRFSS) (2013–2015). We compared fishing workers with both agricultural workers and all-workers. Fishermen commonly reported general exposures, psychosocial exposures, non-standard work arrangements, frequent night shifts, and shift work. The prevalence of musculoskeletal conditions such as carpal tunnel syndrome (33%) and severe low-back pain (27%) was also high. Smoking (45%) and second-hand smoke exposure (25%) were widespread, and 21% reported no health care coverage. National household surveys such as NHIS-OHS, and BRFSS can be utilized to describe the health status of fishermen. This workforce would benefit from increased access to health care and health promotion programs. More comprehensive evaluations of existing data can help to identify occupation-specific health challenges. [ABSTRACT FROM AUTHOR]

Objectives. This paper describes the Northwest Lipid Research Clinic Fat Intake Scale, a brief dietary questionnaire to screen and monitor dietary intake related to plasma cholesterol levels. Methods. The 12-item instrument assesses intake of foods high in fat, saturated fat, and cholesterol. Test-retest reliability was assessed on 194 men and 116 women with high cholesterol prior to a dietary intervention study. To measure validity and responsiveness to dietary change, scores were compared with 4-day food records before and after diet education classes. Results. Test-retest correlation coefficients were .88 for men and .90 for women (2 weeks between scores). Scores for men and women were correlated with nutrients shown by food records at baseline (.47 and .54, total fat; .50 and .51, saturated fat) and 18 months postintervention (.52 and .58, total fat; .56 and .64, saturated fat; all Ps < .001). Mean scores decreased from about 30 to 23 (P < .001, paired t test). Conclusions. The Fat Intake Scale, a qualitative instrument, has acceptable reliability and validity for estimating the level of cholesterol-related diet components and reflects dietary modification. The format of die instrument also lends itself to patient education and goal setting. (Am J Public Health. 1997;87:181-185)